Hi-Way Services Ltd

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Crew Foreman

• Crew Operatives

• Random or Planned

  Random

  Planned

Traffic Management

• 12a

• 12b

• 12c

• 12d

• Description of TM Layout

Site Conditions

• Weather Conditions

• Signs clean and in good order

  Yes

  No

  N/A

• Cones clean and in good order

  Yes

  No

  N/A

• S/G board clean and in good order

  Yes

  No

  N/A

• T/Lights in good working order

  Yes

  No

  N/A

Traffic Orders

• Strategic Roadworks Number required (SRW)

  Yes

  No

  N/A

• Temporary Traffic Regulation order required (TTRO)

  Yes

  No

  N/A

• Portable Traffic Signals License Required (Permit Number)

  Yes

  No

  N/A

Safe System of Work

• Competent Trained Operative in Crew

  Yes

  No

  N/A

• Conforming to Drawings (if provided)

  Yes

  No

  N/A

• TM layout in accordance with Chapter 8

  Yes

  No

  N/A

• Signs and Cones positioned and erected correctly

  Yes

  No

  N/A

• Signs and cones correct size and height

  Yes

  No

  N/A

• Visibility of signs

  excellent

  good

  poor

• Sandbags in use to secure signs

  Yes

  No

  N/A

• Conflicting or Misleading Signage or Signals adequately covered or removed

  Yes

  No

  N/A

• Are TM crew demonstrating good safety awareness

  Yes

  No

  N/A

• Is the TM site creating a safe workplace all operatives

  Yes

  No

  N/A

• Is the TM site creating a safe environment for members of the public

  Yes

  No

  N/A

• Have any near misses been recorded, if yes note NM Doc Number below

  Yes

  No

  N/A

Vehicle Inspection

• DRS filled out

  Yes

  No

  N/A

• Defect Book filled out before start of shift

  Yes

  No

  N/A

• Near Miss Book

  Yes

  No

  N/A

• Vehicle crew pack

  Yes

  No

  N/A

• Fire Extinguishers in date

  Yes

  No

  N/A

• PPE Bags

  Yes

  No

  N/A

• Signs and Equipment correctly secured to vehicle

  Yes

  No

  N/A

• Condition of vehicle chassis bed

  excellent

  good

  poor

• Condition and Cleanliness of Cab

  excellent

  good

  poor

PPE

• Is correct and clean PPE being worn

  Yes

  No

  N/A

• Full High Visibility Clothing

• Hard Hat

• Safety Glasses

• Ear Defenders

• Safety Boots (Steel Toe)

• Gloves

• First Aid Kit

• Burns Kit

TM & Sub-Contractor Vehicle and Equipment

• Strobes, Lightbar and Working lights

  operational

  faulty

• Chevrons, "Highway Maintenance" and 50mm reflective yellow stripe on vehicle

  Yes

  No

  N/A

• Comments

• Auditor

  Sign

• Crew Foreman

  Sign